Disparities in melanoma-specific mortality by race/ethnicity, socioeconomic status, and health care systems

J Am Acad Dermatol. 2023 Mar;88(3):560-567. doi: 10.1016/j.jaad.2022.10.004. Epub 2022 Oct 11.

Abstract

Background: Despite encouraging trends in survival, sociodemographic inequalities persist among patients with melanoma.

Objective: We sought to quantify the effect of race/ethnicity, socioeconomic status, and health care systems on melanoma-specific mortality within an insured population of patients.

Methods: Using a retrospective cohort study, we identified insured adults diagnosed with Stage I to IV melanoma from January 1, 2009, to December 31, 2014, followed through 2017, from the California Cancer Registry. We compared melanoma-specific mortality between insured patients diagnosed within the largest vertically integrated health care system in California, Kaiser Permanente Southern California, and insured patients with other private insurance (OPI).

Results: Our cohort included 14,614 adults diagnosed with melanoma. Multivariable analyses demonstrated that race/ethnicity was not associated with survival disparities, while socioeconomic status was a strong predictor of melanoma-specific mortality, particularly for those with OPI. For example, hazard ratios demonstrate that the poorest patients with OPI have a 70% increased risk of dying from their melanoma compared to their wealthiest counterparts, while the poorest patients in Kaiser Permanente Southern California have no increased risk.

Limitations: Our main limitation includes inadequate data for certain racial/ethnic groups, such as Native Americans.

Conclusions: Our findings underscore the persistence of socioeconomic disparities within an insured population, specifically among those in non-integrated health care systems.

Keywords: health care systems; health disparities; integrated health care systems; melanoma; melanoma-specific mortality; racial disparities; sociodemographic inequalities; socioeconomic status.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • California
  • Delivery of Health Care, Integrated*
  • Ethnicity
  • Health Status Disparities
  • Healthcare Disparities
  • Humans
  • Melanoma*
  • Melanoma, Cutaneous Malignant
  • Retrospective Studies
  • Social Class
  • Socioeconomic Factors